Cost-Effectiveness of Dabigatran for Stroke Prevention

Dabigatran, at the right price, is an attractive option for many atrial fibrillation patients.

Dabigatran (Pradaxa), a direct thrombin inhibitor that recently received FDA approval (JW Gen Med Oct 28 2010), is at least as effective and safe as warfarin for preventing strokes in patients with atrial fibrillation. However, is dabigatran cost-effective? Using a simulated population of patients with atrial fibrillation and CHADS₂ scores 1, researchers developed a mathematical model to compare outcomes and costs for warfarin (targeted international normalized ratio [INR], 2–3) and for twice-daily 150-mg dabigatran. The model was based on annual rates of ischemic stroke of 1.20% for warfarin and 0.92% for dabigatran. Rates of hemorrhage in the model were 0.74% for warfarin and 0.30% for dabigatran. Cost for dabigatran was estimated at US$13 daily.

Projected lifetime patient costs were $143,000 for treatment with warfarin and $168,000 with dabigatran. Compared with warfarin, dabigatran had an incremental cost-effectiveness ratio of $45,000 per quality-adjusted life-year (QALY).

Comment: Many consider QALY costs of $50,000 to be cost-effective. In this computer model, dabigatran costs would remain under this ceiling, assuming that the authors' estimated price of $13 daily is realistic. As of December 2010, the price at several national pharmacy chains was substantial but lower than $13 daily (range, $232–$280 for a 1-month supply of sixty 150-mg tablets). I suspect that most atrial fibrillation patients would gladly switch to dabigatran if a considerable portion of the cost was covered by insurance.

— Jamaluddin Moloo, MD, MPH

Published in Journal Watch General Medicine December 2, 2010

# posted by roodbont @ 8:10 AM